Acute Care Hospitalization

One-third of patients with acute coronary syndrome and diabetes do not have their blood sugar assessed before hospital discharge

Many patients with acute coronary syndrome (ACS, unstable angina or heart attack) also suffer from diabetes, which worsens their prognosis and increases their risk of death. Clinical guidelines recommend aggressive treatment of diabetes and other risk factors for heart problems. Yet nearly one-third of patients with diabetes hospitalized for ACS do not have their blood sugar levels assessed before hospital discharge, according to a new study. In addition, although more than 60 percent of patients with diabetes assessed had poor blood-sugar control, many did not have their diabetic medications adjusted. Novel strategies to improve diabetes care at the time of hospitalization for ACS are needed, suggest the study authors.

Out of 968 patients with ACS, researchers examined the 235 who also had diabetes (24 percent) to calculate the proportion of patients whose glycemic control (HbA1c) was assessed at the time of an ACS hospitalization. They also analyzed characteristics associated with HbA1c assessment and physicians' responses to poor glycemic control. HbA1c values were known or obtained in 69 percent of the ACS patients with diabetes. Of these patients, 60 percent were poorly controlled (HbA1c greater than 7). Patients 60 to 69 years of age were 9 percent less likely and those aged 70 years and older were 29 percent less likely to have their HbA1c assessed than patients younger than 60 years.

Among patients without an HbA1c assessment, consultation by an endocrinologist increased by 60 percent the likelihood of obtaining a subsequent assessment. Among ACS patients with diabetes whose HbA1c was elevated, only 42 percent of those with an HbA1c of 7 to 9 and 69 percent of those with an HbA1c greater than 9 had their diabetic medication regimen intensified.

The study was supported by the Agency for Healthcare Research and Quality (HS11282). More details are in "Assessment of and physician response to glycemic control in diabetic patients presenting with an acute coronary syndrome," by Darcy L. Green Conaway, M.D., Jonathan R. Enriquez, M.D., Jaime E. Barberena, M.D., and others, in the December 2006 American Heart Journal 152, pp. 1022-1027.

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